| Treasure Coast Neurology West, Llc | |
|
1420 Sw Saint Lucie West Blvd Suite 102 Port St Lucie FL 34986-1709 | |
| (772) 873-1005 | |
| (772) 595-9986 |
| Full Name | Treasure Coast Neurology West, Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1420 Sw Saint Lucie West Blvd, Port St Lucie, Florida |
| Authorized Official Name and Position | Lucille Ann Vandevere (OWNER) |
| Authorized Official Contact | 7728731005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Treasure Coast Neurology West, Llc Po Box 881565 Port St Lucie FL 34988-1565 Ph: (772) 873-1005 | Treasure Coast Neurology West, Llc 1420 Sw Saint Lucie West Blvd Suite 102 Port St Lucie FL 34986-1709 Ph: (772) 873-1005 |
| NPI Number | 1619921301 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619921301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | ARNP 3283142 (Florida) | Primary |
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